Comparison of the effects of dexmedetomidine and propofol in reducing recovery agitation in pediatric patients after ketamine procedural sedation in emergency department

Abstract

Background: Ketamine has been a safe and effective sedative agent commonly used for painful pediatric procedures in the emergency department (ED). This study aimed to compare the effect of dexmedetomidine (Dex) and propofol when used as co-administration with ketamine on recovery agitation in children who underwent procedural sedation. Materials and Methods: In this prospective, randomized, and double-blind clinical trial, 93 children aged between 3 and 17 years with American Society of Anesthesiologists Class I and II undergoing short procedures in the ED were enrolled and assigned into three equal groups to receive either ketadex (Dex 0.7 μg/kg and ketamine 1 mg/kg), ketofol (propofol 0.5 mg/kg and ketamine 0.5 mg/kg), or ketamine alone (ketamine1 mg/kg) intravenously. Incidence and severity of recovery agitation were evaluated using the Richmond Agitation-Sedation Scale and compared between the groups. Results: There was no statistically significant difference between the three groups with respect to age, gender, and weight ( P > 0.05). The incidence of recovery agitation was 3.2% in the ketadex group, 22.6% in the ketofol group, and 22.6% in the ketamine group ( P = 0.002, children undergoing short procedures were recruited). There was a less unpleasant recovery reaction (hallucination, crying, and nightmares) in the ketadex group compared with the ketofol and ketamine groups ( P < 0.05). There was no difference in the incidence of oxygen desaturation between the groups ( P = 0.30). Conclusion: The co-administering of Dex to ketamine could significantly reduce the incidence and severity of recovery agitation in children sedated in the ED.

The use of dexmedetomidine in the emergency department: A systematic review

“…Study designs included 11 RCTs, 22,32–41 13 cohort studies and other nonrandomized studies, 19–21,23,42–50 and 11 case series and case reports 12,51–60 . Six of the included studies were conference abstracts 20,21,40,47,50,56 .…”

“…Three trials identified higher rates of adverse events with DEX than with the various pharmacologic comparators. One trial 33 identified higher rates of hypotension with DEX (22.6% with ketamine plus DEX as opposed to 6.5% with ketamine plus propofol or 0% with ketamine alone). Another trial 34 found higher rates of need for supplemental oxygen or airway maneuvers with ketamine plus DEX than with ketamine plus propofol or ketamine alone, and a third trial found higher incidence of transient bradycardia with DEX plus fentanyl (three cases, 8%) than with midazolam plus fentanyl (no cases, 0%) 36 .…”

“…Study designs included 11 RCTs, 22,[32][33][34][35][36][37][38][39][40][41] 13 cohort studies and other nonrandomized studies, [19][20][21]23,[42][43][44][45][46][47][48][49][50] and 11 case series and case reports. 12,[51][52][53][54][55][56][57][58][59][60] Six of the included studies were conference abstracts.…”

Efficacy and safety of ketamine alone and ketamine‐dexmedetomidine combination for sedation for brain computed tomography in paediatric patients with head injuries: A retrospective study

“…7 Contrastingly, dexmedetomidine is known to cause bradycardia and hypotension. 19,20 Mason et al showed reductions in BP and transient bradycardia in a subset of patients injected with dexmedetomidine, and a recent metaanalysis showed a dose-dependent reduction in heart rate in the dexmedetomidine group. 7,14 Ketamine can reverse dexmedetomidine-induced bradycardia and hypotension.…”

Comparison of the Effect of Adding Low-dose Ketamine to Dexmedetomidine and Propofol on the Quality of Sedation and Hemodynamic Response in Children During Upper Gastrointestinal Endoscopy: A Double-blind Randomized Clinical Trial

“…Tosun et al revealed that HR was significantly higher in the Ketadex group than in the Ketofol group (28). Azizkhani et al showed that the mean of PR, MAP, and SpO 2 was not significantly different between the Ketadex and Ketofol groups (10).…”